Home Forums Discussions General Discussion I'll take the $60,000 for what I am already doing

I think I am already doing this?

http://www.nytimes.com/2008/07/21/business/21medho

And, if the median salary of FPs is $150,000, then with my pay, someone must be making over $200,000.

http://www.nytimes.com/2008/07/21/business/21medhome.html?scp=3&sq=physician&st=cse

or, if you don't want to register, use this to get there:

http://query.nytimes.com/search/business?query=increased+doctors%27+fees&x=0&y=0

Cool- I hope that the idea of paying PCPs more does catch on. It's about time. I guess as the number of old people grow and PCP docs fall, we will get paid more simply due to supply/demand economics.

$177,000 median income for an Internist?? Where the Hell is that and how do I get there?

Leslie

I had shared this with some closer friends here in a group PM but felt it was important enough to post here in public for all... If you use the numbers and properly add them up then you will find that 1/3 of all PCP state that if they had a "do-over" they would go into another higher paid, more well respected specialty and because of those two main reasons, and that another 1/3 would not go into medicine at all if granted the same do-over. So:

Clearly 2/3's of all PCP's across the three main specialties would if given Monday Morning Quarter Back free choice would never have been and presently regret going into primary care because of all the hastle combined with the long hours and low pay and low professional respect and satisfaction. That is just so sad that these SOB's have been allowed to drain the life blood and good out of such a wonderful, needed and noble profession.

http://www.merritthawkins.com/pdf/MHA2006SurveyofPrimaryCarePhysicians.pdf

We were also talking about how many of us are now talking our own intelligent kids out of careers in medicine. It used to be just the opposite, parent doctor helped child become doctor and with it I would bet some serious generational knowledge got passed along, ala old medicine man or long term apprenticeship type situation... I mean just imagine my daughter hanging out at the office and even playing assistant on minor procedures, reading charts and discussing them with her mom, the amount of early learning that ya just can't get in a quick four year stint at med school. And now it is all going to be missing, all that generation to generation passed on knowledge because none of us feel confident in there being any meaningful reforms that actually are good for the average hard working PCP. What a shame and a loss for our entire nation. It is something that would take decades to recover from... really. What a pity.

So download the PDF, copy it, attach it and share it with every media outlet, newspaper, TV or radio station you can. This is a crime and the criminals need to be held accountable. Read 'em a weep folks, read 'em and weep...

Paul

Eric,

Thanks for bailing me out on the URL. Don't know how I did that, lol.

Leslie,

I know. And, with $177,000 a year, you could afford to ditch Yahoo and hire a runner to run back and forth with messages.

Leslie,
Join or be a factory! Weeeee!!!! See a new patient ever 7 1/2 minutes, triple book (yes that is right I just heard from a drug rep that one of the largest factories around here is now regularly triple and even sometime quaduple booked!!!) So get on that hamster wheel and go girl. You'll be burnt or dead before you know it and so will half your chronic patients, but hey, it's a living right???

For $177,000 I could at least run in the same circles as a first-year-out-of-school pharmacist! To Hell with Yahoo. Think of all the donkeys I could feed!!

Leslie

It's kind of funny, because everyone has heard of the fact that if you earn $50,000 you will spend $51,000, but if you earn $150,000, you will spend $151,000. I think the same kind of goes for our profession. Whether I see 35 a day or 20 a day, I will probably still come in early and go home late.

But, what they don't say about the first sentence in my post, is that it is probably a heluva lot more fun to spend $151,000 and be in debt than to spend $50,000 and be in debt.

I'm with Leslie.

I'm sorry but in the latter half of 2008 why should any American Med Schooled and residency PCP have to settle for even $150,000 while working the @$$ off? And yes remember these numbers are badly squewed by the guys seeing patients every 7 1/2 minutes while triple, yes triple booked. So for every doc in the middle who is still seeing too many patients than they can properly manage making about the $150K, that means there are many doing the factory thing as well as good ethical docs trying to keep the visits normal and the quality of care up who are starving their ethics. That my dear friends in BULLCCHIT in any language.

It is like the world's most extended residency... The low pay verses the hours performed, for the high level of services and knowledge given is just so totally out of wack, it is almost impossible to believe that it actually is the way it is.

I make no appologies about wanting to have Nancy paid very well for the kind of top quality care, ala IMP, that she provides and the kind of emotional baggage she gets to drag home and in her head. If a lawyer makes 200-300 bucks an hour for studying 4-5 years less than a PCP, then what should a PCP make? Try raising your lawyer for a quick piece of advice at 8 pm on a Saturday night no less 2 in the morning... Please. What does a plumber get for an evening or weekend call??? So as compared to the plumber then what should the doctor be worth? One can care deeply about people and want to provide great care, but since when should a doctor have to be Mother Tereasa while practicing medicine in the richest country in the world? Give me a break.

Bert,
With all these storms moving thru, how's the roof??? Bullcchit.

It is very anxiety provoking, I can tell you that.

Paul, that was an elegant post. And short as well. I think most of the problem lies with the issue that these facts just aren't known by the American public. Probably 95% of the American public and 80% of Congress have no idea that we aren't all rich like it was in the 60s and 70s. Then couple that with having little or no respect. Well, I shouldn't say little or none but much less for sure.

If you look at subjects like global warming (whether it exists or does not), people like Al Gore have brought it to the forefront of the American public. I remeber when you, I believe, posted the newspaper clipping of the Assistant Attorney General or the DOJ guy who spoke out after the OB/Gyn or PCP or whatever said it was great that this would send a message to the doctors who were trying to gouge the American public with higher fees. But, he can say that, because people still believe it.

As I have said before, (and I certainly don't go telling Medicaid patients what my reimbursement is unsolicited), but when they ask, they are not only shocked, they are dumbfounded at the answer.

The fees you get paid, especially if you actually recieve a fee schedule from the carrier is propriety type info and I am almost sure that you can be prosecuted or at least sued for releasing such information! As we said in Vermont as Pillsbury was attacking Ben & Jerry's, "What's the DoughBoy Scared of?" They know if the word got out about how much they undercut us and how they treat us it would half sink them right there....

A level 3 Medicare visit pays approx. $59; a level 4 visit pays $88. The local Minute Clinic at CVS gets $69 for strept throat and $59 for most of the other issues they address. Another urgent care in my city has a $76 minimum charge. Neither has to address multiple chronic medical conditions, field phone calls or get prior auths. They can move patients faster since no one cries on their shoulders or shares their current life experiences. What is wrong with this picture?

I'm pessimistic the Medical Home reimbursement will occur until so many internists and family practice docs have left office practice, they will have no choice but increase pay. Hopefully we can survive until then.

Paul, thanks. But, with all due respect, I just don't see it as being an issue if one of my patients ask what I am reimbursed for his or her visit. And, frankly, I don't care if they prosecute me or sue me. Hey, at least then, the amount I am paid or more truthfully, not paid would become public knowledge.

If Mainecare wants to sue me, they know right where I am. And, they can stop me from using Mainecare, and I would be just as happy. And, then there would be only one other provider accepting Mainecare, but that's because they are paid at FQHC rates.

ok, the JMayer post prompted me to email our Senator and house rep today. Here is what I wrote (with some excerpts directly from jmayer - thanks)

sent to Senator Carl Levin, Debbie Stabenow and House Rep Pete Hoekstra:

>>>

Please focus on fixing the medicare payment system. The recent legislative fix to prevent the 10.6% cut does not address the root of the problem. Physicians need the ability to balance bill their medicare patients to make up for the inability for government to appropriately compensate physicians. The artificially low price controls now put on physicians under Medicare are driving doctors out of medicare. We are considering dropping Medicare and other third party payors ourselves. The low reimbursements from the govt controlled pricing under Medicare are pushing us in this direction.

A level 3 Medicare visit pays approx. $59; a level 4 visit pays $88. Plumbers, lawyers and accountants make more than a physician does for each visit and they don't have to spend 12 years in post graduate training, address multiple chronic medical conditions, or get prior authorizations from insurance companies. Those professionals also don’t have to wait the 30-60 days to get paid from Medicare and other insurance companies or be forced to pay use electronic prescribing or electronic health records. What is wrong with this picture? Hopefully, it is quite apparent.

I'm pessimistic reimbursement improvements directed at primary care physicians will occur until a great number of internists and family practice doctors have left office practice. Already, medical students shun primary care due to the low pay. The government will have no choice but increase pay or allow balance billing once primary care physician shortages occur on a wide scale basis. Hopefully those of us primary care doctors can survive and stay in practice until then.

>>>

Actually the fee you get paid from the insurance company is usually on the EOB sent to the patient (along with what you would have liked to get). Therfore the info is already available to the patient and in my opinion) freely discussable if you so desire.

The truth of the matter is, Patients don't really care what their doc is making or isn't making. There is still the perception that we are overpaid (lets not talk about CEO's, UHC executives, sports figures) The good news for us is that AC is very reasonably priced and we are all (AC users) ecstatic when we find a new free utility that we can use with AC!

Leslie, I keep telling you there is plenty of pasture ground in S Iowa! Donkey's eat grass...? right?

Tom

See that's where I disagree. There is the perception that we are overpaid. I think we are all human and we want to be valued. I am not going to advertise what I make and what Mainecare makes, but in the end, one of the ways that things will change is when people do know what we make. I don't think Congress knows what we make, and that is important if they are the ones who will be changing healthcare.

Eric,
I'm glad my post gave you some inspiration on writing your representatives. Now I have to do the same. Take care.

I have to agree with Bert. I think a lot of patients definitely perceive that doctors, all doctors, are greedy, money-loving, over-paid, golf-playing show-offs. I work very hard to dispel that perception by wearing scrubs rather than expensive clothes to work, keeping the fixtures in my office pleasant but not showy, driving my old truck (which by the way is my only vehicle) and, when asked by patients if I am going on vacation this year replying, "Geeze, I would love to but when I am not at work, it is hard for me to meet payroll and the staff really needs to be paid."

And, Tom, yes donkeys eat grass...unfortunately they are so very sensitive to changes in their environment I fear they would simply droop their ears and pine if I moved them to Iowa. Right now they are enjoying their Jackson County Indiana watermelon rinds.

Leslie

Frankly, there is nothing wrong with being a highly paid, money-loving golf-playing show-off if you went to school and through other training for 10 years (like MDs) to learn the skills to be that. Your patients that are other highly skilled professionals (Engineers, MBAs, etc)don't begrudge doctors being paid alot. But they don't know how little PCPs are being compensated. And like all of us, they want to pay as little as possible for the products/services they purchase.

I'm not sure if people actually believe PCPs are overpaid. But if it is so, it is due the third-party payment system combined with "insurance" being paid for by employers. You get to imagine that the dr is paid (or overpaid) but you don't really see yourself as paying anything..not really. Then you start thinking that you shouldn't have to. Then you resent the $5 copay when it is implemented. Then you freak when the copay goes up to $25. Now you are mad at those "overpaid" doctors who just want your copay. It never occurs to the patients that the copay is really just a way to get them to NOT go to the doctor (for each case of the sniffles). And that it is not in addition to the fee that the insurance company pays you, it is Part of the fee.

Leslie you seem to be agreeing with me a lot lately. That can only be a good thing.

But, you always phrase it much better than I.